Tag Archives: United States Preventive Services Task Force

Breast Cancer Screening: Technology or Radiologist

There’s a lot of press about the importance of a 3-D mammogram (breast tomosynthesis) and how much better it is in terms of detecting cancer than the traditional 2-D (standard digital) mammogram.

Here’s a little known secret:

While it is true that there is a difference in the cancer detection rate between the two technologies, what I notice on a daily basis is that the most important consideration for a patient should actually be who interprets their study.

A mammogram is one of the most subjective radiological studies in the field of radiology and there are huge differences in the breast cancer detection rates between radiologists.

I often see breast cancers that were missed (on both 2-D and 3-D mammograms) that would have been detected if a different radiologist had interpreted the study.

Interestingly, most of these statistics are recorded and regularly reported for radiologists. However, they are rarely made public. In part, there is resistance to releasing data such as this because of the potential for misinterpretation by patients and the public in general.

However, today’s patients are increasingly sophisticated and it is my personal opinion that it may be time to bring awareness to this topic.

-Ryan Polselli, M.D.

Fellowship Trained, Breast Imaging Radiologist

Breast MRI

How Often Should Women Have a Mammogram?

Ryan Polselli
Ryan Polselli

How often should women have a mammogram?

There is so much confusion about this question! I want to try to answer for both healthcare professionals AND patients in the simplest way that I know…

In the past, the general answer was simple…”When you turn 40, get a mammogram every year until you die.” In 2009, a group of healthcare professionals, the United States Preventive Services Task Force (aka USPSTF), gave their best attempt at crunching some numbers to determine the value of the mammogram in terms of risks and benefits. Their recommendation was…”Beginning at age 50, get a mammogram every other year until 74.”

Once they came out with their recommendation, all hell broke loose in the medical field and there has been confusion ever since.  So what happened? Why is there not agreement?

Both groups have argued back and forth about the science and statistics…the sensitivity, specificity, true and false positives, receiver operating characteristic curves, and various other concepts requiring an advanced degree to understand. However, the essence of the difference between the two groups is a difference in human values of what is actually harmful versus what is actually beneficial.  The USPSTF places more emphasis on the harm that arises from unnecessarily diagnosing and treating a suspicious area of the breast (the so called false positives) than the benefit that arises from diagnosing and treating a cancer. The result is a recommendation for fewer mammograms.

While this may not sound that bad, the problem is what follows as a result. The USPSTF acknowledges that with a decreased frequency of screening mammograms beginning later in life, more women will lose their life to breast cancer.

And so it goes…

In general, the opinion of those close to breast cancer will strongly favor the traditional recommendation. This is on reason why the official recommendation of the American Cancer Society remains…”When you turn 40, get a mammogram every year for as long as you are in good health.”

Ryan Polselli, M.D.

Breast Imaging Radiologist

**Please note, high risk patients should see their doctor and may have different recommendations.